Podcast appearances and mentions of david glaser

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Best podcasts about david glaser

Latest podcast episodes about david glaser

Monitor Mondays
Into a Rabbit Hole: Medical Loss Ratio Fraud Detected in Managed Care Program

Monitor Mondays

Play Episode Listen Later Sep 29, 2025 28:55


A recent case filed by the U.S. Department of Justice (DOJ) reveals how an insider was able to detect fraud in a large managed care organization (MCO).Although the topic of medical loss ratio (MLR) might be arcane to some, when the subject involves millions of dollars of potential fraud, it quickly becomes a large blip on the government's fraud detection radar.More on this topic will be reported during the next live edition of Monitor Mondays. That's when whistleblower attorney Max Voldman returns to the long-running Internet broadcast to report on how a payer, Inland Empire Health Plan, miscalculated its MLR in a scheme to rebate less money to the government than to which it was legally obligated.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Whistleblowers Bring Total Knee Replacement DME to its Knees

Monitor Mondays

Play Episode Listen Later Sep 22, 2025 28:14


Three whistleblowers brought a durable medical equipment (DME) provider to its knees.In two separate cases, the whistleblowers targeted Exactech, a manufacturer of total knee replacement (TKR) systems, resulting in a settlement of $8 million to resolve alleged violations of provisions of the False Claims Act (FCA).Famed whistleblower attorney Mary Inman, partner in the law firm of Whistleblower Partners, LLP, will report the excoriating details of the settlement during the next live edition of Monitor Mondays.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley at Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Histoire Vivante - La 1ere
L'Afrique du Sud et la Suisse : une histoire en or et en ombres (1/5) : Le paradoxe Jan Smuts / première partie

Histoire Vivante - La 1ere

Play Episode Listen Later Sep 15, 2025 27:02


Lorsqu'on évoque les relations avec l'Afrique du Sud, il y a toujours un petit froid qui s'installe dans la conversation, une ombre au tableau dans l'histoire suisse du XXème siècle, parce que l'apartheid a été condamné tardivement et qu'il n'a pas empêché qu'on fasse des affaires avec ce pays où le racisme d'Etat a très officiellement dominé de 1949 à 1991. Retour sur quarante ans de cette relation sulfureuse avec la plateforme indépendante geneveMonde.ch éditée par la FONSART, Fondation pour la sauvegarde et le développement du patrimoine audiovisuel de la RTS Jan Smuts est un homme d'État sud-africain, juriste et philosophe, qui défend tout à la fois la paix internationale et une vision impérialiste et raciste dans la gouvernance planétaire. Né dans la colonie du Cap britannique, il est premier ministre d'Afrique du Sud à la sortie de la Première guerre mondiale de 1919 à 1924 et pendant la Deuxième guerre mondiale. David Glaser a rencontré Thomas Gidney, chercheur postdoctoral à l'université de Genève, qui a publié sur les relations des colonies avec les grandes instances internationales comme l'ONU et son ancêtre, la Société Des Nations.

Histoire Vivante - La 1ere
L'Afrique du Sud et la Suisse : une histoire en or et en ombres (2/5) : Le paradoxe Jan Smuts / Deuxième partie

Histoire Vivante - La 1ere

Play Episode Listen Later Sep 15, 2025 28:07


Nous poursuivons le portrait de Jan Smuts, homme d'Etat sud-africain, impérialiste et raciste convaincu, qui illustre les ambivalences de l'ordre colonial mondial à la recherche d'un équilibre mondial de paix incarné par la Société des Nations puis par l'ONU. Un équilibre étrange à nos yeux du XXIe siècle ou le racisme d'Etat cohabite avec la recherche d'un universalisme mais un universalisme hiérarchisé, où paix et progrès ne remettent pas en question les discriminations raciales. Chercheur à l'université de Genève, Thomas Gideney retrace la suite de la trajectoire politique internationale de Jan Smuts au micro de David Glaser.

Histoire Vivante - La 1ere
L'Afrique du Sud et la Suisse : une histoire en or et en ombres (3/5) : le mouvement anti-apartheid de Genève – La société civile entre en action

Histoire Vivante - La 1ere

Play Episode Listen Later Sep 15, 2025 28:33


Si la Suisse officielle a ménagé l'Afrique du Sud de l'apartheid au profit de leurs échanges commerciaux et financiers, la société civile a parfois pris une position toute différente. Aline Martello, doctorante au département d'Histoire de l'Université de Lausanne, raconte l'action du Mouvement anti-apartheid de Genève (MAAG), entre 1964 et 1971, mais aussi de l'engagement des militantes comme Michael Pentz, physicien au CERN, L'Organisation européenne pour la recherche nucléaire, les réseaux académiques, protestants et syndicaux impliqués. Elle répond aux questions de David Glaser.

Histoire Vivante - La 1ere
L'Afrique du Sud et la Suisse : Une histoire en or et en ombres (4/5) : Une "amitié" en or

Histoire Vivante - La 1ere

Play Episode Listen Later Sep 15, 2025 27:48


Dans cet épisode, nous nous intéressons aux raisons de la condamnation tardive du régime d'apartheid sud-africain par la Suisse. L'historienne Sandra Bott est allée aux sources des relations économiques entre les deux Etats pour comprendre comment, au cours de la Guerre froide, la Suisse a maintenu des liens financiers et commerciaux étroits avec Pretoria, malgré sa posture officielle de neutralité. Circuits de l'or, rôle ambigu de la Banque Nationale Suisse, crédits massifs et activités opaques de sociétés comme Glencore témoignent d'une diplomatie économique parfois complice. Aujourd'hui encore, la mémoire de ces relations reste sensible et son héritage pèse encore sur le système financier suisse. Sandra Bott répond aux questions de David Glaser.

Histoire Vivante - La 1ere
L'Afrique du Sud et la Suisse : Une histoire en or et en ombres (5/5) : Une affaire d'Etat

Histoire Vivante - La 1ere

Play Episode Listen Later Sep 15, 2025 28:01


Pour ce dernier épisode, on s'intéresse à la fabrique d'un reportage sensible de nos collègues de Temps Présent, excellente émission de la RTS, aujourd'hui encore diffusé tous les jeudis soirs de 20h à 21h sur RTS 1. Celui qui nous intéresse est diffusé le 29 avril 1999 sous le titre "Sur la piste suisse des chimistes de l'apartheid". L'auteur de ce reportage, Jean-Philippe Ceppi, fait le récit d'une mission épique pour révéler les liens secrets entre les services de renseignement suisses et le régime d'apartheid, malgré la neutralité officielle de la Suisse. Échanges d'informations sensibles, armes chimiques, réseau clandestin : Jean-Philippe Ceppi met au jour une collaboration fondée sur une logique de la guerre froide. Arrêté au Cap en mars 1999, le journaliste est brièvement détenu, victime d'une tentative d'intimidation. Il déplore aujourd'hui encore le silence persistant des autorités, révélateur, d'un attachement profond à la raison d'État au détriment de la transparence démocratique. Jean-Philippe Ceppi répond aux questions de David Glaser.

Monitor Mondays
When Whistleblowers Can't Whistle

Monitor Mondays

Play Episode Listen Later Sep 15, 2025 29:55


Healthcare compliance just shifted fundamentally.Traditional whistleblowers who needed inside access are being replaced by artificial intelligence (AI)-powered relators who mine public datasets and flag statistical anomalies that could signal fraud.The U.S. Department of Justice (DOJ) logged 979 qui tam cases in 2024, many of which were reportedly triggered by mathematical outliers, rather than insider tips. Government agencies, such as the Centers for Medicare & Medicaid Services (CMS), have already recovered $820 million using algorithmic detection.During the next live edition of Monitor Mondays, senior healthcare analyst Frank Cohen will reveal a possible solution for hospitals, health systems, and physician practices.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Audit Alert: Who's Auditing AI?

Monitor Mondays

Play Episode Listen Later Sep 8, 2025 30:28


Consider this a wake-up call.As artificial intelligence (AI) quietly becomes part of the audit trail, healthcare leaders must ask a new question: who's reviewing the reviewers?During the next live edition of the venerable Monitor Mondays broadcast, contributing editor Sharon Easterling will break down why auditing AI tools are no longer a tech issue – they're a documentation integrity and compliance priority.Although this is an important topic for all healthcare professionals, register now to learn why it's particularly relevant for those in compliance and revenue integrity.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Des Ondes Vocast
Interview David Glaser - Les secrets de Maxximum

Des Ondes Vocast

Play Episode Listen Later Sep 7, 2025 17:43


Olivier Oddou reçoit David Glazer, animateur et journaliste dans le média radio depuis plus de vingt ans. Avec David on fera une petite page nostalgie sur Maxximum, la radio électro historique qui a tant marqué les esprits entre 1989 et 1992. David prépare un livre sur cette radio après de nombreux entretiens avec les membres historiques de la station.Animation / réalisation : Olivier OddouIntervenants : Rémy Bertholon, Julien VigierInvités : Laurent Petitguillaume et David GlaserCrédits musicaux : Rob - It's a blast (BO du film 'Radiostars'), jingles produits par Pure Jingles [https://purejingles.com/]Voix off : Estelle Hubert [https://estellehubert.com]ContactPar mail : contact@vocast.fr [https://www.vocast.fr/contact.html]Twitter : @DesOndesVocast [https://twitter.com/DesOndesVocast]

Monitor Mondays
Is the UPIC Fraud Prevention System Broken?

Monitor Mondays

Play Episode Listen Later Aug 25, 2025 30:29


The Unified Program Integrity Contractors (UPICs) are household names in healthcare compliance.But their track record tells a troubling story, according to senior healthcare analyst Frank Cohen. These Medicare fraud enforcement contractors are using controversial extrapolation techniques that providers successfully challenge over 60 percent of the time on appeal.Cohen, who will be the special guest during the next live edition of Monitor Mondays, said he will examine how the 2016 consolidation created five regional enforcement powerhouses, along with why their statistical methodologies are devastating practices based on flawed assumptions. Cohen intends to show how misaligned incentives are creating systematic accuracy problems, while revealing why the current UPIC system might be fundamentally broken, despite everyone agreeing that fraud prevention matters.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
A Reign of Terror for Providers

Monitor Mondays

Play Episode Listen Later Aug 18, 2025 30:02


There just might be a reign of terror being experienced at many of America's hospitals and health systems. Professionally delivered patient care apparently seems to be getting hijacked by auditors compelled to deny claims of omission.Aided by the Centers for Medicare & Medicaid Services (CMS) and abated by auditors private and public, the lingua franca appears be an entanglement of descriptors, namely “inpatient versus outpatient.”During the next live edition of the venerated Monitor Monday broadcast, several of the most recognized names in healthcare will not add to the confusion, but offer advice for those on the front lines of battle.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Invalid Prescriptions Trigger CVS Omnicare Whistleblower Lawsuit

Monitor Mondays

Play Episode Listen Later Aug 11, 2025 28:21


Although the lawsuit was filed by a pharmacist in New Mexico, a federal judge in New York has ordered CVS Omnicare to pay $949,000 to settle a False Claims Act (FCA) case.According to news sources, the Pharmacy Benefits Manager (PBM) allegedly prescribed drugs to individuals in long-term residential facilities that were not supported by valid prescriptions and then submitted claims for reimbursement for those prescriptions to Medicare, Medicaid, and TRICARE. Although a jury trial was held last spring, with the judge rejecting post-trial arguments by Omnicare, it is understood that Omnicare plans to appeal.Reporting details of this whistleblower lawsuit during the next edition of Monitor Mondays will be Max Voldman, a partner at Whistleblowers Law, LLP.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
340B: Fighting Back Against Big Pharma

Monitor Mondays

Play Episode Listen Later Aug 4, 2025 28:09


Federal legislation has been introduced that is intended to help the beleaguered 340B Health organization via an effort to ban pharmaceutical companies from restricting access to the drug pricing discount program of the same name, through community and specialty contract pharmacies.Reporting this lead story as well as other updates from Congress and the Trump Administration during the next live edition of Monitor Mondays will be Maureen Testoni, CEO for 340B Health and a frequent guest on the long-running broadcast. Testoni represents more than 1,600 hospitals and health systems participating in the 340B drug pricing program.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
The Changing Audit Landscape

Monitor Mondays

Play Episode Listen Later Jul 28, 2025 28:44


The rugged audit landscape has changed – and not for the better.Today, there are more potential pitfalls and traps to capture the unprepared and impact them with huge fines and possible incarceration. In fact, the Centers for Medicare & Medicaid Services (CMS) has erected a legal fortress to protect their audit process. It's not the same old ballgame – it's a new one, with lots of new players.It's also why the producers of Monitor Mondays have invited senior healthcare analyst Frank Cohen to return to the broadcast to describe how you and your team can learn how to identify red flags in the process of fraud detection in order to avoid liability.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
An OPPS Oops?

Monitor Mondays

Play Episode Listen Later Jul 21, 2025 30:00


The Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule for the 2026 fiscal year has been released.Tucked inside the Proposed Rule from the Centers for Medicare & Medicaid Services (CMS) is the agency's recommendation to phase out the Inpatient-Only List (IPO) over the course of the next three years.Reporting the lead story on this development during the next edition of Monitor Mondays will be longtime panelist Ronald Hirsch, MD.The weekly broadcast will also include these instantly recognizable features:• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Medicaid Madness

Monitor Mondays

Play Episode Listen Later Jul 14, 2025 29:30


It's a Medicaid Madness mess.For many years, Medicaid has been providing support for America's most vulnerable populations. But now, Medicaid finds itself as a pawn, being manipulated for political gain between two opposing forces: those who view the program as a means to an end to reduce government spending, and those who hold the opposite point of view.Who will be the winners and losers? During the next live edition of the venerated Monitor Mondays, senior healthcare consultant Dennis Jones will report on how hospitals can save money in the face of the inevitable Medicaid cuts.Jones, senior director of revenue cycle at Jefferson Health, was among the first of hand-picked subject-matter experts heard nearly 14 years ago on the weekly Internet broadcast produced by RACmonitor.The Monday's broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Sitting in for healthcare attorney David Glaser will be attorney Marguarite Ahman, a shareholder in the law offices of Fredrikson & Byron.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Breaking News: A Major Regulatory Shift

Monitor Mondays

Play Episode Listen Later Jul 7, 2025 28:52


The Transparency in Coverage (TiC) Final Rule represents one of the most significant regulatory shifts in healthcare pricing since the implementation of the Patient Protection and Affordable Care Act.During the next live edition of Monitor Mondays, senior healthcare analyst Frank Cohen will walk you and your team through the comprehensive labyrinth of changes.Recent enforcement developments, including President Trump's Executive Order 14221, directing actual hospital price disclosure within 90 days, also signal an intensified regulatory environment requiring proactive compliance strategies.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Moesha Baptiste, intern regulatory analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Chevron Deference: What Difference Has a Year Made?

Monitor Mondays

Play Episode Listen Later Jul 7, 2025 29:35


Looking back and looking ahead, we must reckon with a major shift in America's judicial landscape: the elimination of the so-called Chevron Deference. Last year, at about this same time, physician and attorney Dr. John K. Hall was the special guest here on Monitor Mondays, and he began his segment explaining the legal concept.Now, more than a year after the U.S. Supreme Court's landmark decision overturning 40 years of judicial precedent and upending statutory construction and enforcement, we must ask, has anything really changed?Dr. Hall will return to examine the changes – or maybe lack of changes – and what we might still expect regarding legal challenges to executive actions.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior regulatory affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Fraud, Waste, and Abuse: The 2025 Triple Crown

Monitor Mondays

Play Episode Listen Later Jun 23, 2025 31:52


Call it a trifecta, triumvirate, or the Triple Crown of 2025.“Fraud, waste, and abuse” is the current triple-negative buzzword in America's lexicon. And it's being used to describe lots of things. But when that phrase is used by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), what does it actually mean?You'll learn during the next live edition of Monitor Mondays.That's when senior healthcare consultant Dr. Drew Updike – the broadcast's special guest – will report on how the Acting HHS Inspector General (IG) Juliet Hodgkins used that phrase when she recently posted an online promotion in support of the OIG Spring Semiannual report to Congress.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Compliance Quicksand: Sepsis

Monitor Mondays

Play Episode Listen Later Jun 16, 2025 30:15


Clinical denials by payers for sepsis continues. The problem: the definition of the enigmatic condition does not meet their propriety definitions.Enter Dr. James Kennedy, who will be the special guest during the next live edition of the long-running Monitor Mondays broadcast. Dr. Kennedy will report on his recent conversations with the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, in which the agency described its protocols in amending the Index and Table to fit new diseases and terminology.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Medicaid Madness

Monitor Mondays

Play Episode Listen Later Jun 9, 2025 31:13


The nation's Medicaid program has seen better days. Recently, the federal government's program to provide healthcare coverage to America's low-income and vulnerable citizens was used as a bargaining chip as congressional Republicans were in the throes of budget negotiations, facing the daunting task to pass what President Trump calls his “big, beautiful bill:” a package of tax breaks disproportionately favoring the wealthy and spending cuts. The bill, which last week passed in the U.S. House of Representatives, is now making its way through the Senate.Then there was the announcement this midweek that the Deputy Administrator and Director of the Center for Medicaid and Children's Health Insurance Program (CHIP) Services, Drew Synder, was resigning from the federal agency.Reporting on these developing stories during the next live edition of the long-running Internet broadcast Monitor Mondays will be Drew Updike, MD.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Whistleblower Update: Rheumatologist Sentenced to Jail, Must Forfeit Maserati and Other Possessions

Monitor Mondays

Play Episode Listen Later Jun 2, 2025 29:27


During the next edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner at Whistleblower Law, will provide an update on a whistleblower case that some consider “beyond bad.”You'll learn why a Texas rheumatologist who was sentenced to 10 years in prison and three years of supervised release was ordered to forfeit more than $28 million, plus 13 real-estate properties, a jet, and a Maserati GranTurismo sports car.Inman, long considered one of the nation's foremost whistleblower attorneys, will be the program's special guest during the next live edition of the venerable Internet broadcast, coming up at 10 a.m. EST on Monday, June 2, 2025.The long-running broadcast will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Field Report: Drew Updike will continue his reporting on efforts by the Trump Administration to intervene in healthcare issues – namely the Centers for Medicare & Medicaid Services (CMS) Form 64 related to migrants and Medicaid.

Monitor Mondays
Tariffs: The Impact on Drugs

Monitor Mondays

Play Episode Listen Later May 19, 2025 30:00


Welcome to a strange new world.Recent tariffs announced by the Trump Administration are likely to impact drug manufacturing, since many drug components are produced outside the U.S., in nations such as in India, giving rise to state laws. Many states limit overseas involvement relative to the Health Insurance Portability and Accountability Act (HIPAA). Florida, for example, prohibits the offshoring of certain patient data, requiring such storage to be within the U.S.Responding to this emerging crisis, the producers of RACmonitor and Monitor Mondays have invited Lexi Morrison, director of operations at MedPharma, to be the program's special guest during the next live edition of the venerable Internet broadcast, coming up at 10 a.m. EST on Monday, May 19.The long-running broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Monitor Mondays
Speak No Evil: Asking Docs to Weigh In Became a $202 Million False Claims Act Settlement

Monitor Mondays

Play Episode Listen Later May 12, 2025 33:18


On the surface, it was the perfect scam: kickbacks to docs in exchange for public speaking engagements, in order to induce them to prescribe drugs.That's apparently what Gilead Sciences thought.But a whistleblower blew the whistle, and Gilead admitted to paying hundreds of thousands of dollars to high prescribers of their HIV drugs to serve as speakers at programs at luxury restaurants.Famed whistleblower attorney Mary Inman, partner at Whistleblowers Partners, LLP, will report the savory details during the new live edition of Monitor Mondays, coming up at 10 a.m. EST on Monday, May 12.The long-running broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Folan Houston, assistant general counsel for Zelis, will report on the news at the intersection of healthcare and congressional action.• Field Report: Dr. Drew Updike continues his reporting on recent efforts by the Trump Administration to prevent providers from undertaking gender-affirming treatments for America's LGBTQ+ population.

Monitor Mondays
340B In the Crosshairs

Monitor Mondays

Play Episode Listen Later May 5, 2025 28:01


Once again, the venerable 340B Drug Pricing Program finds itself in the crosshairs of critics – this time, from the U.S. Congress.Recently, Sen. Bill Cassidy (R-La.), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a report outlining his office's investigation into the program.During the next live edition of Monitor Mondays, 340B Health CEO Maureen Testoni will return to the broadcast to offer her response to the senator's investigation.The long-running broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news at the intersection of healthcare and congressional action.

Monitor Mondays
Audit Alert: Immigration in Healthcare

Monitor Mondays

Play Episode Listen Later Apr 28, 2025 29:58


Nearly every day, on any news service, images of people being quickly led away is chilling as the current Administration continues its sweep of rounding up and deporting suspected illegal immigrants.Thus, in this current climate of increased audits, investigations and scrutiny on immigration, it is essential that healthcare organizations sponsoring foreign nationals for employment, ensure that documentation, policies, and practices are updated and fully compliant.During the next live edition of the venerable Monitor Mondays live Internet radio broadcast, seasoned immigration attorney Matthew Webster will walk you through such essential issues as H-1B visas, L-1 visas and employment-based green cards. Webster is also expected to report on requirements from the Department of Labor (DOL) and the United States Citizenship and Immigration Services (USCIS).Webster, senior immigration attorney at the law firm of Fredrikson & Byron, will discuss the impact of material changes when H-1B amendments are required.The long-running broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on congressional action taking place in Washington, D.C.

Monitor Mondays
FY 2026 IPPS: Hospital Strategy for Risk Adjustment, Equity, and Reimbursement

Monitor Mondays

Play Episode Listen Later Apr 21, 2025 29:20


The fiscal year (FY) 2026 Inpatient Prospective Payment System (IPPS) proposed rule introduces significant reforms to hospital reimbursement, risk adjustment, and performance measurement.Key changes include the Centers for Medicare & Medicaid Services (CMS) transition to HCC Version 28, the use of the Community Deprivation Index (CDI) for socioeconomic risk adjustment and expanded inclusion of Medicare Advantage data in quality metrics.Launching in 2026, the proposed rule mandates episode-based payments with enhanced pricing accuracy. Hospitals must adapt by updating financial models, realigning quality strategies, and fostering cross-departmental collaboration. These changes emphasize equity, accountability, and transparency, all of which is designed to help in the positioning hospitals to lead in a value-driven healthcare environment.Strategic readiness is critical to thrive under IPPS 2026. Reporting this story, during the next live edition of Monitor Mondays, will be the broadcast's special guest Penny Jefferson.The long-running broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Folana Houston, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• News Update: Dr. Drew Update will have an update to his recent reporting on transgender treatment practices.

Monitor Mondays
HHS, CMS Latest Apparent Battlegrounds for Social Wars Being Waged by Trump Administration

Monitor Mondays

Play Episode Listen Later Apr 14, 2025 30:38


A flurry of national news reports continues to document the large-scale restructuring taking place at the U.S. Department of Health and Human Services (HHS), where 10,000 jobs were reportedly slashed earlier this month, a move also impacting the workforce at the Centers for Medicare & Medicaid Services (CMS). An estimated 300 CMS workers are expected to be affected by this action, while NPR reported that the HHS teams focusing on sexual violence prevention were also eliminated – on the first day of April's Sexual Assault Awareness Month.Also recently, RACmonitor and Monitor Mondays have come into possession of a CMS memo, dated March 5, in which the agency warns that it may take action to prevent hospitals and other providers suspected of using “dangerous chemicals and surgical mutilation of children” relative to gender dysphoria, which the agency claims have “proliferated.” In fact, other executive actions taken by the Trump Administration also appear to have anticipated deleterious impacts on the health of America's LGBTQ+ population.It seems part of an overarching theme in which the Administration is waging social wars using gutted federal agencies more as a weaponized tactic than as a mechanism to serve the public.Reporting this story during the next live edition of Monitor Mondays will be physician Drew Updike, a recognized leader in hospital utilization management, denials, clinical documentation integrity (CDI), coding, and hospital operations.The long-running broadcast will also include these instantly recognizable features:• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• Monday Rounds: Dr. Shaemarke Magan, medical director for CaroMont Health in Gastonia, North Carolina, will make his Monday rounds, substituting for Dr. Ronald Hirsch.

Monitor Mondays
Caught in the Crossfire: How to Avoid Pay-and-Chase Enforcement Tactics

Monitor Mondays

Play Episode Listen Later Apr 7, 2025 31:29


A recent case, United States v. Junyi Liu, reveals how a $23 million fraud scheme exemplifies vulnerabilities in America's healthcare system – as you'll discover when senior healthcare analyst Frank Cohen joins the next Monitor Monday broadcast.You'll also learn about the challenges legitimate providers face when navigating complex regulations – and more about the government's aggressive “pay-and-chase” enforcement tactics, plus why innocent practitioners often get caught in the crossfire.During the next live edition of the venerable weekly Internet broadcast, Cohen will also report on potential policy reforms.The long-running broadcast will also include these instantly recognizable features:• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• Monday Rounds: Dr. Bonney Olney, director of Level of Care Service for R1 RCM, will make her Monday rounds, substituting for Dr. Ronald Hirsch.

Monitor Mondays
Wound Care: An Open Source for Audits

Monitor Mondays

Play Episode Listen Later Mar 31, 2025 29:56


No matter the approach one might take for debridement, wound care continues to be an attractive source for audits – they inevitably arise and fester. Case in point: Wachler and Associates, a prestigious law firm in Michigan, currently is representing clients in some 18 wound care audit cases.That is why RACmonitor, producers of Monitor Mondays, has invited Andrew “Drew” Wachler, founder of Wachler & Associates, to be the special guest during the next live edition of the venerable weekly Internet broadcast.The long-running broadcast will also include these instantly recognizable features:• Breaking News: Famed whistleblower attorney Mary Inman, partner at Whistleblower Law, will report about a False Claims Act (FCA) settlement involving a Medicare Advantage provider.• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Advanced Beneficiary Notice: A Doctors' Day Observance

Monitor Mondays

Play Episode Listen Later Mar 24, 2025 30:41


National Doctors' Day is actually Sunday, March 30, but the one-day nationwide observance is getting an early celebratory start during the next live edition of the venerable Monitor Mondays broadcast.Joining our esteemed panelists will be three well-known physicians: Drs. Stephanie Van Zandt, Clarissa Barnes, and Juliet Ugarte Hopkins. And each doc will have an “open mic” during the 30-minute live Internet broadcast.The long-running weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
At the Intersection of CDI and the False Claims Act

Monitor Mondays

Play Episode Listen Later Mar 17, 2025 30:15


A clinical documentation integrity (CDI) professional who “knowingly … acts in reckless disregard of the truth or falsity of the information” may ultimately run into issues related to the federal False Claims Act (FCA).The Medicare Fee-for-Service (FFS) Compliance Program on the Centers for Medicare & Medicaid Service (CMS).gov website lists several CMS compliance programs designed to educate and support Medicare providers in “understanding and applying” FFS policies. If the hospital compliance department is not monitoring these resources, it would be prudent for CDI leadership to do so, according to CDI expert Cheryl Ericson, who will be the special guest during the next live edition of the long-running Monitor Mondays Internet broadcast.The venerable weekly Internet broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the latest news concerning healthcare legislation.

Monitor Mondays
Why Complications are Complicated

Monitor Mondays

Play Episode Listen Later Mar 10, 2025 31:43


Hospitals routinely measure, analyze, and track adverse patient harm events, collecting information about and reporting on certain types of such events in order to meet the Centers for Medicare & Medicaid Services (CMS) program and state legal requirements.Prior work plans of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) revealed that hospitals reported few harm events to state reporting systems.During the next live edition of Monitor Mondays, Dr. James Kennedy, president of CDIMD, will unwrap the January 2025 OIG proposal (OEI-06-18-00401) to evaluate hospital quality reporting, suggesting how hospitals' clinical documentation integrity (CDI) and coding workflows can address errors of omission or commission.Access the OIG's announcement at https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000907.asp.The venerable weekly Internet broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.

Histoire Vivante - La 1ere
La Suisse et le nucléaire 2/5 : La Confédération et ses rêves de bombe atomique, du secret à la critique

Histoire Vivante - La 1ere

Play Episode Listen Later Mar 3, 2025 27:40


En 1962, la Suisse entame la construction de sa toute première centrale nucléaire à Lucens dans le canton de Vaud. Le pays utilise l'énergie nucléaire pour produire de l'électricité depuis 1969. Avec Michael Fischer, historien et spécialiste de la bombe atomique suisse, au micro de David Glaser. Un tout petit pays et une technologie de destruction massive. A partir de la fin des années 1950 en Suisse, on en apprend un peu plus sur les projets de fabrication d'une bombe atomique Swiss Made. La crainte s'installe et l'imaginaire d'une bombe destructrice est aussi porté par les mouvements artistiques, avec Friedrich Dürrenmatt. Pour évoquer cette œuvre de Friedrich Dürrenmatt, David Glaser a rencontré Duc Hahn Luong du centre Dürrenmatt à Neuchâtel.

Histoire Vivante - La 1ere
La Suisse et le nucléaire 5/5 : Genève, le village gaulois anti-nucléaire

Histoire Vivante - La 1ere

Play Episode Listen Later Mar 3, 2025 27:14


La critique du CERN, l'organisation européenne pour la recherche nucléaire, gronde dans les années 1980 avec la sortie du livre La Quadrature du CERN écrit par Lucile Hanouz, militante syndicale, Andre Gsponer, physicien des particules; Pierre Lehmann, ingénieur-physicien et Jacques Grinevald, philosophe et historien des sciences. Un montage d'archives autour de l'histoire de La Quadrature du CERN et un entretien avec le petit fils de l'écrivain et philosophe neuchâtelois Denis de Rougemont, Philippe de Rougemont, écologiste, impliqué dans les associations Sortir du Nucléaire et Noé21 et député du Grand conseil genevois, interrogé par David Glaser pour Histoire Vivante.

Histoire Vivante - La 1ere
La Suisse et le nucléaire 4/5 : Les anti-nucléaires du bout du Lac, 50 ans de contestation genevoise

Histoire Vivante - La 1ere

Play Episode Listen Later Mar 3, 2025 27:24


En 1969, la Confédération a signé le Traité de non-prolifération nucléaire. La Suisse n'aura pas de bombe atomique. Si le programme suisse d'armement nucléaire n'est vraiment enterré qu'en 1988, elle est toujours championne des abris antiatomiques. Le pays a aussi une histoire de la contestation antinucléaire, notamment à Genève. Mais à partir de quelle date peut-on commencer à tracer cette histoire ? Nicolas Stenger, historien à l'Université de Genève et spécialiste de l'œuvre de Denis de Rougemont, répond à David Glaser. Également Frédéric Deshusses, responsable des Archives contestataires à Carouge et Ivo Rens, Professeur émérite de droit à l'Université de Genève et fondateur de l'Association pour l'Appel de Genève.

Histoire Vivante - La 1ere
La Suisse et le nucléaire 1/5 : Genève dans la matrice de l'atome

Histoire Vivante - La 1ere

Play Episode Listen Later Mar 3, 2025 29:08


Après Tchernobyl, Fukushima a eu raison du nucléaire, au moins pour un temps. La guerre en Ukraine et les fractures du marché mondial de l'énergie ont transformé le regard sur les atouts de l'atome à usage civil et les débats ont repris de plus belle sur les avantages et les risques de cette source d'énergie. Dans cette nouvelle série d'Histoire Vivante en association avec Genève-Monde, on explore l'histoire du nucléaire en Suisse, de l'enthousiasme des débuts aux affres persistants du doute. On a des images de la bombe atomique avec le champignon nucléaire d'Hiroshima et ses victimes, surprises par une force de destruction inédite en 1945. On connait un peu moins les usages très quotidiens du nucléaire civil. C'est pourtant un objet central de la coopération internationale d'après-guerre. Le nucléaire a transfiguré les rapports de force dans cette nouvelle ère. Véronique Stenger est historienne et spécialiste de l'histoire des organisations internationales. Avec elle, on explore les usages dits " pacifiques " du nucléaire. Elle répond aux questions de David Glaser pour Histoire Vivante.

Histoire Vivante - La 1ere
La Suisse et le nucléaire 3/5 : LE CERN, un accélérateur de la coopération scientifique européenne à Genève

Histoire Vivante - La 1ere

Play Episode Listen Later Mar 3, 2025 28:23


Nous racontions précédemment l'ambition des autorités fédérales suisses de se doter de la bombe atomique. Mais l'histoire du nucléaire en Suisse ne se résume pas à la bombe. La Suisse a aussi joué un rôle important en matière de recherche nucléaire. Cet effort est incarné par le CERN, le Centre européen pour la recherche nucléaire, qu'on trouve sur l'Esplanade des Particules à Meyrin. Un monument et son histoire commentée par Dominique Pestre qui répond à David Glaser pour Histoire Vivante. D'abord physicien, il bifurque vers l'histoire et termine une thèse consacrée à l'histoire culturelle de la physique dans l'entre-deux-guerres en France. Dans les années 1990, il s'intéresse aux relations entre recherche scientifique et démocratie.

Monitor Mondays
DEVELOPING STORY: No Public Comment Allowed for HHS Rulemaking

Monitor Mondays

Play Episode Listen Later Mar 3, 2025 32:41


Across America, in sprawling university teaching facilities and in picturesque rural hospitals, administrators are dealing with a powerful tool called statistical extrapolation.When auditors say that they're using statistical “sampling” to review your Medicare claims, what they are often doing is using extrapolation – which could take what might appear to be minor discrepancies in your billing and turn them into major financial obligations.To learn more about extrapolation and what it means for you and your team, the producers of RACmonitor have invited senior healthcare analyst Frank Cohen to be the special guest during the next live edition of Monitor Mondays.The venerable weekly Internet broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.

Monitor Mondays
Hot Off the Presses: Latest Issues Impacting Medicare Home Health Care, Hospice, and Medicaid Services

Monitor Mondays

Play Episode Listen Later Feb 24, 2025 29:41


During the next edition of Monitor Mondays, special guest Bill Dombi, senior counsel with Arnall, Golden, and Gregory, will offer an update on the hot-button issues affecting home healthcare, hospice, and long-term home care. These issues include the latest developments related to the Medicare Hospice Special Focus Program, the impact of the Medicare home health payment model, Medicare Advantage (MA) claim denials in post-acute care, and increasing threats to Medicaid support.The venerable weekly Internet broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the latest news concerning healthcare legislation.

Monitor Mondays
1.2 Billion in Fraudulent Claims for Wound Care Procedures

Monitor Mondays

Play Episode Listen Later Feb 17, 2025 30:37


Evoking the age-old adage of having “skin in the game,” a Phoenix, Arizona couple last month entered a plea of guilty to one of the largest healthcare frauds in U.S. history.The couple pleaded guilty to criminal charges involving the submission of $1.2 billion in fraudulent claims to Medicare, Medicaid, and other insurers for wound care procedures. The husband-and-wife team have agreed to pay more than $600 million in restitution and face over 20 years in prison, according to famed whistleblower attorney Mary Inman, who will return to Monitor Mondays for its next edition.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.

Monitor Mondays
Major Challenges Facing American Hospitals Explained

Monitor Mondays

Play Episode Listen Later Feb 10, 2025 29:58


Challenges in reimbursement, benchmarking, and quality reporting are being experienced in many American hospitals. Why is this problem arising?Our special guest during the next live edition of Monitor Mondays will have answers. Penny Jefferson, a seasoned healthcare professional who serves as the Director of Clinical Documentation Integrity (CDI) Services at the University of California at Davis Medical Center, will report on why misinterpretation of the admission types appears to be the culprit, impacting compliance, payment, and patient safety indicators (PSIs).The broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.

Talk Ten Tuesdays
“The Police Are Here!” What Should You Know?

Talk Ten Tuesdays

Play Episode Listen Later Feb 4, 2025 30:51


When a law enforcement officer comes to your facility, what do you need to know? And what should you do?While until recently, this topic was seldom on the top of lists ofhealthcare issues, a recent move by the Trump Administration (Executive Order) appears to have revoked a longstanding policy that prevented federal law enforcement agents (U.S. Immigration and Custom Enforcement) from going to certain areas long considered safe – think hospitals and schools – to conduct enforcement activities.So, what should you do – and what can you do, legally?Register now to attend the next live edition of Talk Ten Tuesdays, coming up at 10 a.m. EST on Feb. 4, when healthcare attorney David Glaser will weigh in on the topic as the broadcast's special guest.Listen and learn as Glaser will tell you what you and your team can and should do when faced with these unusual and unwelcomed visits.Also part of the broadcast will be these instantly recognizable panelists, who will report more news during their segments:• Social Determinants of Health: Tiffany Ferguson, CEO for Phoenix Medical Management, Inc., will report on the news that is happening at the intersection of medical record auditing and the SDoH.• CDI Report: Cheryl Ericson, Director of Clinical Documentation Integrity (CDI) for the vaunted Brundage Group, will have the latest CDI updates.• The Coding Report: Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for First Class Solutions, will report on the latest coding news.• News Desk: Timothy Powell, ICD10monitor national correspondent and regulatory expert, will anchor the Talk Ten Tuesdays News Desk.• MyTalk: Angela Comfort, veteran healthcare subject-matter expert, will co-host the long-running and popular weekly Internet broadcast. Comfort is the assistant vice president of revenue integrity for Montefiore Health.

Monitor Mondays
Artificial Intelligence and Healthcare: Three Critical Areas You Need to Know About

Monitor Mondays

Play Episode Listen Later Feb 3, 2025 28:24


Artificial intelligence (AI) is becoming as commonplace in healthcare as billing audits.It's ubiquitous.And that is why the producers of Monitor Mondays have invited senior healthcare analyst Frank Cohen to explore the intersection of AI and healthcare. So, during the next live edition of the venerable live weekly Internet broadcast, Cohen will address key concerns for compliance professionals, including Health Insurance Portability and Accountability (HIPAA) requirements, data governance, and responsibility in AI-driven decision-making.The broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the latest news concerning healthcare legislation.

Monitor Mondays
Stargate Promises New Advancements in Medicine. Compliance Unclear

Monitor Mondays

Play Episode Listen Later Jan 27, 2025 28:52


Earlier this week, in the wake of the inauguration of President Donald Trump, a major announcement was made that some hope will lead to new advances in healthcare: “Stargate,” a private venture to build in the U.S. hyperscale data centers for artificial intelligence (AI). The strategic goal is to make the United States the world's leader in AI.Larry Ellison, founder of the relational database company Oracle, indicated that much work in this project will be focused on healthcare, including the promise of better medical diagnostics and imaging, personalized medicine, remote monitoring, and telehealth for patients, according to Edward M. Roche, RACmonitor investigative reporter, whose day job is director of scientific intelligence for Barraclough New York LLC.Roche will be reporting this lead story for the next edition of the long-running Monitor Mondays weekly broadcast.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on current healthcare legislation.

Monitor Mondays
Major False Claims Act Settlement Snags New York's Independent Health

Monitor Mondays

Play Episode Listen Later Jan 13, 2025 30:41


New York health insurer Independent Health and its former executive reached a settlement that will amount to up to $100 million with the U.S. Department of Justice (DOJ) and a whistleblower over False Claims Act allegations that they made Medicare members appear sicker than they really were to get more money from the government, a practice known as risk adjustment fraud.Betsy Gaffney, former CEO of now-defunct vendor DxID, agreed to pay $2 million to resolve allegations she helped DxID mine patients' medical records for diagnoses that risk-adjust, nudging doctors to approve them up to a year after the patient visits, all while pocketing up to 20 percent of the additional revenue generated for Independent Health by these unsupported diagnoses.Reporting the lead story during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm Whistleblower Partners.More than four weeks since its last news broadcast, Monitor Mondays will return this coming Monday with a cadre of the smartest minds in healthcare auditing. You'll hear auditing news you won't find anywhere else – except here and in RACmonitor.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on current healthcare legislation.Register now to listen to this exclusive news edition of Monitor Mondays; all this and more will be coming up at 10 a.m. EST on Jan. 13, 2024.

Monitor Mondays
May I have the Envelope: 2024 Healthcare Heroes to be Revealed

Monitor Mondays

Play Episode Listen Later Dec 16, 2024 28:43


“He's making a list, checking it twice…”With a nod to the legendary Tin Pan Alley composer Haven Gillespie, who penned the lyrics to the iconic holiday song, senior healthcare consultant Ronald Hirsch, MD has been making his own list of healthcare professionals all year, paying close attention to their deeds in the field of healthcare.Calling them “Hirsch's Heroes,” an annual tradition that began in 2015, Hirsch will reveal those to whom he has bestowed the esteemed honor during the next live edition of Monitor Mondays.Other broadcast segments will include these instantly recognizable features:• The RAC Report: Healthcare attorney Knicole Emanuel will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Field Report: Phyisican and attorney Dr. John K. Hall is expected to file a field report on the recent Anthem Blue Cross Blue Shield proposal relative to its anethesia policy which the giant payer has since abandoned.• Legislative Update: Matthew Albright, chief leglistative affairs analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

Monitor Mondays
Health Insurers in the Spotlight in the Wake of CEO Slaying

Monitor Mondays

Play Episode Listen Later Dec 9, 2024 28:41


Have you ever had your insurance company deny payment for your claim?Have you ever had your insurance company stall or deny a pre-authorization?How long did it take to get the authorization for the medication you've been using to keep yourself alive for the past few years? Was it maddening?During the next edition of Monitor Mondays, physician and attorney Dr. John K. Hall will examine the frustration that modern health insurance has become – especially in the context of the recent fatal shooting of a prominent health insurance chief executive officer (CEO).Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior healthcare legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Histoire Vivante - La 1ere
Suisse-Algérie (1/5) : Les premiers pas

Histoire Vivante - La 1ere

Play Episode Listen Later Nov 25, 2024 29:28


La Suisse, et Genève en particulier, ont joué un rôle important dans les négociations qui ont conduit à l'indépendance de l'Algérie. Grâce à son engagement diplomatique et à l'accueil de pourparlers confidentiels, la Confédération a permis aux représentants algériens de préparer des discussions décisives et d'accéder aux médias internationaux. Cependant, les relations entre la Suisse et l'Algérie remontent aux années 1830, avec la présence suisse dans les territoires colonisés par la France, soulevant pour elle, comme pour la France, la question de la décolonisation. Cette série croise deux entretiens et deux regards rassemblés par David Glaser pour geneveMonde.ch et Histoire Vivante : l'un avec Marisa Fois, historienne de l'Université de Genève, spécialiste de l'Afrique du Nord, et l'autre avec Abdelmadjid Sana, ancien militant du FLN réfugié en Suisse. Depuis le XIXème siècle, des Suisses ont tissé des liens étroits avec l'Algérie, notamment par l'intermédiaire de la Compagnie genevoise des Colonies suisses de Sétif. Bien que la Suisse n'ait jamais été une puissance coloniale, elle a contribué à la colonisation avec ces empires voisins. Avec Marisa Fois, historienne et autrice du livre : Héritages coloniaux - Les Suisses d'Algérie et Abdelmadjid Sana, ancien diplomate d'Algérie et auteur du livre Cris de douleurs des profondeurs du Rhumel.